HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Submit a response View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Feigin, K. N. Articles by Cohen, M. A. Search for Related Content PubMed PubMed Citation Articles by Feigin, K. N. Articles by Cohen, M. A.

Clinical Breast Examination in a Comprehensive Breast Cancer Screening Program: Contribution and Cost¹

¹ From the Guttman Diagnostic Center, Memorial Sloan-Kettering Cancer Center, 55 Fifth Ave, 12th Floor, New York, NY 10003 (K.N.F., D.M.K., P.M.T.); and Department of Radiology, Breast Imaging Center, University of Virginia at Charlottesville, Charlottesville, VA (M.A.C.). From the 2004 RSNA Annual Meeting. Received August 16, 2005; revision requested October 17; revision received December 29; accepted February 1, 2006. Address correspondence to K.N.F. (e-mail: feigink{at}mskcc.org).

Purpose: To retrospectively evaluate the cost of clinical breast examination (CBE) and its contribution to screening mammography in the detection of breast cancer.

Materials and Methods: The study received a waiver of authorization from the institutional review board, informed patient consent was not required, and the study was compliant with HIPAA regulations. The records of 60 027 consecutive asymptomatic patients who underwent screening mammography were retrospectively reviewed. CBE was performed on all patients by a nurse practitioner. Patients with positive CBE findings were required to convert from screening to diagnostic evaluation; the number of cancer diagnoses that resulted was determined. The reports, four-view mammograms, or both of patients requiring conversion to diagnostic evaluation were reviewed to determine those patients likely to undergo diagnostic imaging on the basis of screening mammographic findings alone. The cost of CBE was calculated and divided by the number of cancers detected solely with CBE to determine the cost of CBE per additional cancer detected.

Results: Four hundred seventy-four (age range, 32–95) of 60 027 asymptomatic patients had positive CBE findings which required conversion to diagnostic evaluation. Forty-six cancers in 44 patients were subsequently diagnosed; 32 would have been detected with mammography alone, whereas 14 were imperceptible at screening mammography. The cost of CBE was $122 598 per cancer detected solely with positive CBE findings.

Conclusion: CBE performed by nurse practitioners led to the diagnosis of 14 cancers in 13 patients with mammographically occult tumors (0.02% of the screening population and approximately 3% of all cancers diagnosed at the facility during this study). The cost of detecting these additional cancers is estimated to be $122 598 per cancer.

© RSNA, 2006

This article has been cited by other articles:

				M. Robson and K. Offit Management of an Inherited Predisposition to Breast Cancer N. Engl. J. Med., July 12, 2007; 357(2): 154 - 162. [Full Text] [PDF]

eLetters: